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General NPI Number Information
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NPI Number | 1063553188
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Entity Type | Individual
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Provider Name | BRADLEY KEITH HARRISON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 2012 VANESTA PL STE 220
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City | MANHATTAN
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State | KS
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Zip | 66503-4101
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Country | US
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Telephone | 857-064-3277
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Fax | 785-600-2225
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Provider Business Mailing Address
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Address Line | 2012 VANESTA PL STE 220
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City | MANHATTAN
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State | KS
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Zip | 66503-4101
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Country | US
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Telephone | 785-706-4327
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Fax | 785-600-2225
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2007001609
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 04-33249
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License Number State | KS
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